IBD Flashcards
(14 cards)
What 2 conditions is IBD an umbrella term for?
UC and Crohn’s disease
Both involve inflammation of the walls of the GI tract and are associated with periods of remission and exacerbation.
Crohn’s vs UC?
When is IBD suspected in children and teenagers?
If they’re presenting with perfuse diarrhoea, abdominal pain, bleeding, weight loss or anaemia.
They may be systemically unwell during flares with fevers, malaise and dehydration.
What are some extra-intestinal manifestations of IBD?
IBD patients can develop signs outside the GI system: finger clubbing, erythema nodosum, pyoderma gangrenosum, episcleritis and iritis, inflammatory arthritis, primary sclerosing cholangitis (UC).
What investigations are used for IBD?
Blood test: anaemia, infection, thyroid, kidney and liver function, raised CRP indicates active inflammation.
Faecal calprotectin: released by the intestines when inflamed. Endoscopy (OGD and colonoscopy) with biopsy is the gold standard investigation for the diagnosis of IBD. Imaging with USS, CT and MRI can be used to look for complications eg. fistulas, abscesses and strictures.
What is the general management for IBD?
Essential to monitor growth and pubertal development in children with IBD, especially during exacerbations or when treated with steroids. Management involves inducing remission during flares and maintaining remission, with dietician input.
What is the first line management to induce remission in Crohn’s?
- first line = steroids (eg. oral prednisolone or IV hydrocortisone)
- enteral nutrition if concerns about steroids affecting growth in children (specially formulated liquid diet oral or NG, replacing the patients diet
- azathioprine
- mercaptopurine
- methotrexate
- infliximab
- adalimumab
how does enteral nutrition induce remission?
- Treating nutritional deficiencies
- Improving the gut microbiome
- Removing inflammatory foods
What is the first line management to maintain remission in Crohn’s?
1st line: Azathioprine, mercaptopurine.
Alternatives include methotrexate, infliximab, adalimumab.
What is the surgical management for Crohn’s?
When the disease only affects the distal ileum, it’s possible to resect this area to prevent further flares. Surgery can be used to treat strictures and fistulas secondary to Crohn’s.
management to induce remission in mild to moderate UC?
- First line: aminosalicylate (eg. mesalazine oral or rectal)
- second line: corticosteroids eg. prednisolone
management to induce remission in severe UC?
- first line: IV corticosteroids (eg. hydrocortisone)
- second line: IV ciclosporin
What is the management to maintain remission in UC?
Aminosalicylate eg. mesalazine oral or rectal, azathioprine, mercaptopurine.
What is the surgical management for UC?
UC only affects the colon and rectum, so removing the colon and rectum (panproctocolectomy) will remove the disease.
The patient is then left with either a permanent ileostomy or an ileo-anal anastomosis (J-pouch), where the ileum is folded back on itself and fashioned into a larger pouch that functions like the rectum. This ‘J pouch’ is then attached to the anus and collects stools prior to the person passing a motion.
